A modified wake-up test for use in very young children undergoing spinal surgery.

In a consecutive series of five very young children undergoing hemivertebrectomy and fusion, a modified intraoperative wake-up test was used to confirm neurologic integrity. Standard leads attached to a nerve stimulator and positioned over the plantar aspect of each foot were used to apply tetanic electrical stimulation at the time of intraoperative wake-up. Four children responded vigorously with flexion and extension of the knees and ankles after only minimal delay. One neurologically intact child did not respond because of technical issues. This report describes our favorable preliminary experience with this technique.